A5500 HCPCS code: For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe
A5500 is the HCPCS Level II code for for diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe. The 2026 Medicare DMEPOS fee schedule pays $90.63 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume fell 15% from 2022 to 2024 (514,091 to 439,506 services). In 2024, 6,136 suppliers billed Medicare for A5500 (purchases), serving 220,231 beneficiaries; California, Florida, New York accounted for 25% of services. Its average fee ranks 9 of 10 A55 codes (family range $36.96–$271.80).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 38 — DMEPOS: orthotics, prosthetics, prosthetic devices and vision services |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 1995-01-01 |
| Last action effective | 2005-01-01 |
2026 Medicare DMEPOS fee schedule for A5500
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $90.63 | $90.63 | $108.76 | $81.57 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $90.63 | — |
| AL | — | $90.63 | — |
| AR | — | $90.63 | — |
| AZ | — | $90.63 | — |
| CA | — | $90.63 | — |
| CO | — | $90.63 | — |
| CT | — | $90.63 | — |
| DC | — | $90.63 | — |
| DE | — | $90.63 | — |
| FL | — | $90.63 | — |
| GA | — | $90.63 | — |
| HI | — | $90.63 | — |
| IA | — | $90.63 | — |
| ID | — | $90.63 | — |
| IL | — | $90.63 | — |
| IN | — | $90.63 | — |
| KS | — | $90.63 | — |
| KY | — | $90.63 | — |
| LA | — | $90.63 | — |
| MA | — | $90.63 | — |
| MD | — | $90.63 | — |
| ME | — | $90.63 | — |
| MI | — | $90.63 | — |
| MN | — | $90.63 | — |
| MO | — | $90.63 | — |
| MS | — | $90.63 | — |
| MT | — | $90.63 | — |
| NC | — | $90.63 | — |
| ND | — | $90.63 | — |
| NE | — | $90.63 | — |
| NH | — | $90.63 | — |
| NJ | — | $90.63 | — |
| NM | — | $90.63 | — |
| NV | — | $90.63 | — |
| NY | — | $90.63 | — |
| OH | — | $90.63 | — |
| OK | — | $90.63 | — |
| OR | — | $90.63 | — |
| PA | — | $90.63 | — |
| PR | — | $90.63 | — |
| RI | — | $90.63 | — |
| SC | — | $90.63 | — |
| SD | — | $90.63 | — |
| TN | — | $90.63 | — |
| TX | — | $90.63 | — |
| UT | — | $90.63 | — |
| VA | — | $90.63 | — |
| VI | — | $90.63 | — |
| VT | — | $90.63 | — |
| WA | — | $90.63 | — |
| WI | — | $90.63 | — |
| WV | — | $90.63 | — |
| WY | — | $90.63 | — |
How the A5500 fee compares
| Measure | Value |
|---|---|
| Rank among 10 A55 codes (lowest = 1) | 9 |
| Family fee range (average of state fees) | $36.96–$271.80 |
| Rural fee uplift | — |
Who bills A5500 (2024)
| Measure | Value |
|---|---|
| Suppliers billing rentals | — |
| Suppliers billing purchases | 6,136 |
| Referring clinicians | 62,303 |
| Medicare beneficiaries | 220,231 |
| States with claims | 53 |
| Share of services in top 3 states (California, Florida, New York) | 25% |
| Year | Suppliers | Beneficiaries |
|---|---|---|
| 2022 | 7,356 | 257,703 |
| 2023 | 6,846 | 233,713 |
| 2024 | 6,136 | 220,231 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for A5500, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 514,091 | 257,703 | $77.36 | $58.98 |
| 2023 | 466,248 | 233,713 | $83.77 | $63.67 |
| 2024 | 439,506 | 220,231 | $86.15 | $65.50 |
States with the most A5500 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 46,861 | $65.76 |
| Florida | 32,415 | $66.29 |
| New York | 31,509 | $65.53 |
| Pennsylvania | 25,799 | $65.55 |
| Illinois | 23,912 | $64.73 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 2 | Published Contractor Policy |
Medicare policy articles for this code
- A52457: Ankle-Foot/Knee-Ankle-Foot Orthoses - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A52501: Therapeutic Shoes for Persons with Diabetes - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (436 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| E08.610 | Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy | 2 |
| E09.610 | Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy | 2 |
| E10.610 | Type 1 diabetes mellitus with diabetic neuropathic arthropathy | 2 |
| E11.610 | Type 2 diabetes mellitus with diabetic neuropathic arthropathy | 2 |
| A52.16 | Charcot's arthropathy (tabetic) | 1 |
| E08.00 | Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) | 1 |
| E08.01 | Diabetes mellitus due to underlying condition with hyperosmolarity with coma | 1 |
| E08.10 | Diabetes mellitus due to underlying condition with ketoacidosis without coma | 1 |
| E08.11 | Diabetes mellitus due to underlying condition with ketoacidosis with coma | 1 |
| E08.21 | Diabetes mellitus due to underlying condition with diabetic nephropathy | 1 |
Showing 10 of 436. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for A5500
- 2026-01-01: Average state fee rose 2.0%: $88.85 to $90.63
- 1995-01-01: A5500 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A5500?
A5500 is the HCPCS Level II code for for diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe. Short descriptor: "Diab shoe for density insert".
How much does Medicare pay for A5500?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $90.63. Rural fees can be higher.
Does Medicare cover A5500?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A5500?
Medicare policy articles that cite A5500 list 436 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include E08.610 (Diabetes mellitus due to underlying condition with diabetic neuropathic arthropathy), E09.610 (Drug or chemical induced diabetes mellitus with diabetic neuropathic arthropathy), E10.610 (Type 1 diabetes mellitus with diabetic neuropathic arthropathy). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Did the Medicare fee for A5500 change in 2026?
The average non-rural state fee moved from $88.85 in 2025 to $90.63 in 2026 (+2.0%). CMS's next quarterly HCPCS and DMEPOS update takes effect January 1, 2027.
How many units of A5500 can be billed per day?
2 on DME suppliers (NCCI medically unlikely edits).
Related A55 codes
- A5501 — For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoe ($271.80–$271.80)
- A5503 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoe ($45.79–$45.79)
- A5504 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoe ($45.79–$45.79)
- A5505 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoe ($45.79–$45.79)
- A5506 — For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoe ($45.79–$45.79)
- A5507 — For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe ($45.79–$45.79)
- A5508 — For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoe
- A5510 — For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoe
- A5512 — For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each ($36.96–$36.96)
- A5513 — For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each ($55.16–$55.16)
- A5514 — For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each ($55.16–$55.16)
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Next steps
- Run a reimbursement report for a device billed under A5500
- Watch A5500 for fee, coverage and descriptor changes
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Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.